Healthcare Provider Details

I. General information

NPI: 1942168794
Provider Name (Legal Business Name): JENNY KIM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST, ORLANDO
ORLANDO FL
32803
US

IV. Provider business mailing address

601 E ROLLINS ST, ORLANDO, FL 32803
ORLANDO FL
32803
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5600
  • Fax:
Mailing address:
  • Phone: 407-303-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11041465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: